Emergency Department (ED) Nurse Care Manager is responsible for establishing, coordinating, and maintaining the process to optimize patient throughput to the most appropriate level of care while facilitating interdisciplinary care across the continuum for the ED. The Nurse Care Manager collaborates with the patient/family, multidisciplinary team, physicians, community resources and payers to ensure the patient’s progress and level of care is appropriately determined for the emergency episode of care and for the inpatient encounter to ensure that care is performed and facilitated in an efficient and cost-effective manner.  

Include, but are not limited to:

• Level of Care Determination: Completes initial medical necessity review on all ED patients with potential for admission, works with providers to identify appropriate level of care designation. Documents in accordance with established policy and procedure. Educates ED physicians and nurses about medical necessity and admission criteria.
• Refers High Risk Patients to Social Services: Utilizes Social Work screening criteria to make appropriate social work referrals. Identifies patient/families with complex psychosocial, ongoing medical discharge planning issues, continuing care needs and refers to the social worker.
• Implements Actions to Prevent Readmission: Collaborates with medical staff to recommend referrals for outpatient care, home health or other community agencies as indicated.  Provides post-discharge follow-up by conducting or delegating the telephone evaluation of discharge plan. Works with time to establish interventions to manage high utilizers.
• Supports Patient Flow: Intervenes to expedite the completion of diagnostic tests needed to determine disposition, offers alternatives to admission when appropriate, engages in boarder rounds to determine any needed changes in disposition.
• Initiates discharge planning by conducting screenings for social determinants of health and initial discharge planning assessments for patients admitted through the emergency department.
• Maintains knowledge of Federal, State, and other regulatory agency rules and regulations including The Joint Commission, CMS, Medicare, including but not limited to, knowledge of CMS rules regarding Observation status, the 2 Midnight Rule, and Medicare Inpatient Only Procedures. 
• Maintains knowledge of continuum of cares resources and provides education and resources relevant to the effective progression of care, utilization of services, appropriate level of care, and safe patient transition to the patient/family and health care team. 
• Identifies potential risk management and/or quality issues and works with the healthcare team to resolve such issues or refer them through the Chain of Command structure to the appropriate resource/committee

Other duties as assigned by management

• BSN or Bachelor’s Degree in related field .
• Prior clinical experience in care and management of inpatient hospitalized patients.
• Experience in acute care utilization, preferred.
• Utilization review or case management training from a professional Case Management organization, preferred.
• RN license required/NJ.
• Case Management certification preferred.  
• Data and computer skills
• Knowledge of relevant and state utilization review and appeals requirements

CentraState Healthcare System, in partnership with Atlantic Health System, is a fully accredited, not-for-profit, community-based health system dedicated to providing comprehensive health services in central New Jersey. Beyond offering a wide range of advanced diagnostic and treatment options, CentraState is committed to being a valuable health partner, focusing on disease prevention, promoting healthy behaviors, and helping individuals of all ages live well.

Located in Freehold, CentraState includes a 284-bed acute-care hospital, a dynamic health and wellness campus, two award-winning senior living communities, a charitable foundation, and convenient satellite health pavilions. These pavilions offer primary care, specialty physician practices, and access to outpatient services such as lab work and physical therapy.

CentraState is proud to be among the less than two percent of hospitals nationwide to earn Magnet® designation for nursing excellence five times. Additionally, it has been recognized as a Great Place to Work-Certified™ Company by Great Place to Work® for four consecutive years.

Joining CentraState means becoming part of a pioneering healthcare facility committed to high-quality, patient-focused care. We invite you to make a difference in our community and advance your career with us. We support our employees with work/life balance initiatives, tuition assistance, career advancement opportunities, and more.

Discover why our employees love their jobs and being part of the CentraState family!

CentraState Health System offers a competitive and comprehensive Total Rewards package that supports the health, financial security, and well-being of all team members.

What We Offer:

• Medical, Dental, Vision, Prescription Coverage (30 hours per week or above for full-time and part-time team members)
• Life & AD&D Insurance
• Long-Term Disability (with options to supplement)
• 403(b) Retirement Plan with employer match
• 401(a) Retirement Plan with employer contribution
• PTO
• Tuition Reimbursement
• Well-Being Rewards
• Employee Assistance Program (EAP)
• Fertility Coverage, Healthy Pregnancy Program
• Flexible Spending & Commuter Accounts
• Pet, Home & Auto, Identity Theft and Legal Insurance
• Growth Opportunity and Workforce Development Initiatives
• Continuing Education / Onsite Training
• A warm, welcoming company culture based upon mutual respect and a collaborative goal of providing excellent patient care
• Concierge Services with Work & Family Benefits
• Magnet recognized healthcare facility

Compensation Range: $48.00 - $81.60 per hour

The compensation above reflects the established range from CentraState Healthcare System (CSHS) for this position at the time the job was posted. CSHS considers many factors to determine compensation, including education, experience, skills, licenses, certification, and training.  As such, team member compensation may fall outside this range. 

Additionally, the compensation range reflects base salary and does not include extra shift rates or incentives tied to quality, productivity, etc., as applicable.

The benefits outlined also reflect CSHS’ policy at the time of posting.  Benefits as are made available to other similarly situated team members of CSHS, although participation is at all times in accordance with and subject to the eligibility and other provisions of such plans and programs. CSHS may modify its benefits plans or programs at any time.

CSHS is proud to comply with all pay equity and pay transparency laws.